Youth Basketball Registration form

City of Henderson
2015 YOUTH BASKETBALL LEAGUES
Program goals | Everyone plays • Positive coaching • Balanced teams • Open registration • Good sportsmanship
AGE DIVISIONS
The effective date of age determination
for basketball is the player’s age as of
September 30, 2014. Players who are
at least 5 years old as of this date are
eligible to participate.
Division
U6
U8
U10
U12
U14
U19
Age
5
6-7
8-9
10-11
12-13
14-18
Eligible Birth Dates
10-1-07 thru 9-30-08
10-1-05 thru 9-30-07
10-1-03 thru 9-30-05
10-1-01 thru 9-30-03
10-1-99 thru 9-30-01
10-1-94 thru 9-30-99
ENROLLMENT
One child: $50
Two siblings: $45/child
Three or more siblings: $40/child
Players must be from the same
immediate family to receive the
discount. We reserve the right to
request supporting documentation.
WAYS TO REGISTER
Online and mail-in registration:
September 8-November 19
Drop-off registration:
October 27-November 19 (accepted
at all recreation centers, the Sports
Office and player ratings, space
permitting)
Mail your registration to:
Arroyo Grande Sports Complex,
298 Arroyo Grande Blvd., Henderson, NV 89014
Or enroll online at:
cityofhenderson.com/parks
City of Henderson leagues are designed to guide each participant through an organized program
and to develop the fundamental skills of basketball while emphasizing fun and sportsmanship.
• U6 and U8 divisions are co-rec with no scores or standings kept
• Days, times and locations of practices are at the volunteer coach’s discretion
• Teams are formed according to the player rating system
• Space is limited
• All games are held on Saturdays at the league’s discretion
PLAYER RATINGS
Player ratings will be held at Black Mountain Recreation Center (BMRC) at 599 Greenway Rd.
on Friday, November 21 and Monday, November 24 and Henderson Multigenerational Center
(HMGC) at 250 S. Green Valley Pkwy. on Saturday, November 22.
Division
November 21
November 22
November 24
BMRC
HMGCBMRC
No ratings for U6 or U8
U10. . . . . . . . . . . . . . . . . . 6pm . . . . . . . . . . . . . . . . . . 9:30am. . . . . . . . . . . . . 6pm
U12. . . . . . . . . . . . . . . . . . 7pm . . . . . . . . . . . . . . . . . . 10:30am. . . . . . . . . . . . 7pm
U14/U19. . . . . . . . . . . . . . 7:30pm. . . . . . . . . . . . . . . . 11am. . . . . . . . . . . . . . 7:30pm
Practices begin week of December 8 | Season begins January 3 | Season ends February 21
REGISTRATION CODES
Zone 1: For youth residing within 89002, 89005, 89009, 89011, and 89015 ZIP codes
Zone 2: For youth residing within 89011, 89014, 89074, and Las Vegas ZIP codes (except 89123 & 89183)
Zone 3: For youth residing within 89012, 89044, 89052, 89053, and 89183 ZIP codes
Zone
Division
Code
Zone
Division
Code
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
U6 Co-Rec
U6 Co-Rec
U6 Co-Rec
U8 Co-Rec
U8 Co-Rec
U8 Co-Rec
U10 Boys
U10 Boys
U10 Boys
U10 Girls
U10 Girls
U10 Girls
U12 Boys
U12 Boys
U12 Boys
631000-68
631001-68
631002-68
631003-68
631004-68
631005-68
631027-68
631006-68
631007-68
631008-68
631009-68
631010-68
631011-68
631012-68
631013-68
1/2/3
1
2
3
1/2/3
All
All
U12 Girls
U14 Boys
U14 Boys
U14 Boys
U14 Girls
U19 Boys
U19 Girls
631014-68
631017-68
631018-68
631019-68
631020-68
631025-68
631026-68
Interested coaches
631030-00
Volunteer Coach Information
The City of Henderson Parks and Recreation Department requires all of its volunteer coaches to be NYSCA certified and to complete a background
check. The certification is obtained by completing one of the training sessions offered during each youth sports season. Coaches are encouraged
to submit a volunteer application at cityofhenderson.com /parks. Click on “Sports,” then “Coaches.” Only serious inquiries please.
Coach’s Name:_____________________________ Address:__________________________________ City/ZIP Code:____________________
1st Phone:___________________ 2nd Phone:____________________ Email:_____________________________________________________
Please indicate the grade/division in which you are interested:
Division:__________________Child’s Name:_____________________________________________________________ Child’s Age:________
Division:__________________Child’s Name:_____________________________________________________________ Child’s Age:________
Do you plan to coach with someone? (Circle one) Yes No If yes, please complete the information listed below:
Coach’s Name:_______________________Child’s Name:___________________________________________________ Child’s Age:________
Please see reverse side to complete your registration form and/or to complete volunteer coach information.
Youth Sports Registration Form
THIS FORM CAN BE COPIED • PLEASE PRINT AND FILL OUT COMPLETELY
Sports Office • 298 Arroyo Grande Blvd., Henderson, NV 89014
Parent/Guardian: First
Last
Street Address
Apt.#
Home Phone
Cell Phone
Age
Age
Email Address
Height
Gender
Height
Gender
Last
Participant #3: First
Birthdate
ZIP
Last
Participant #2: First
Birthdate
Emergency Phone
State
Last
Participant #1: First
Birthdate
City
Age
Height
Gender
All refunds are subject to a $5 service charge.
Parents may request placement with ONE other player who is registered in the same division, for U6 and U8 divisions ONLY.
• Multiple player requests will not be honored. • Request must be mutual (the player you request must request you).
• U10 – U19 division player requests will not be honored; teams are formed by the player ratings system in these divisions.
• Requests submitted after player rating days will not be honored. • Requests for placement with specific coaches will not be honored.
Player requests are one of many variables considered when making teams. These requests are not guaranteed. The Sports Office will make
final determination on roster placement. Please confirm the player you request is enrolled in the program. Sports Office is not obligated to
honor requests after player rating dates. Place your request here:
U6 U8 division.
_____________________________ requests to be with______________________________. Both players are registered in the _________
Your child’s name
Requested child’s name
Please circle one
Please confirm the player you request is enrolled in the program. Sports Office is not obligated to honor requests after player rating dates.
RELEASE
I, as the participant or parent or legal guardian of the above-named child, hereby give permission for his/her/my participation in the above-listed activity(ies). I further authorize,
without my prior approval, the rendering of any emergency medical treatment that may become necessary due to his/her/my participation in the activity(ies).
In consideration of the permission granted to me or the above-named child to participate in the activity(ies) listed above, I do hereby agree, on my own behalf as the participant
or, if the parent or legal guardian, on my own behalf and on behalf of the above-named child, to release the City of Henderson, its Parks and Recreation Department, and its officials,
administrators, employees, agents, representatives, and volunteers from any and all actions, causes of action, damages, claims, or demands of whatever kind or nature which I or the abovenamed child may have against the City of Henderson, its Parks and Recreation Department, or the other above-listed parties for any injuries, known or unknown, which are incurred by, arise
from, or in any way relate to my or the above-named child’s participation in the activity(ies) described above.
The City of Henderson is not responsible for lost or stolen items.
The City of Henderson reserves the right to reconcile customer balances should the customer have available credit on their account.
I represent that I am the parent or legal guardian of this child or that I have permission from the child’s parent or legal guardian to enroll the child in this activity; and grant and give the
City of Henderson the right to use my or my child’s photograph or image, with or without my or my child’s name, both individually and in conjunction with other persons or objects for any and
all purposes including, but limited to, private or public presentations, advertising, publicity and promotion.
I have read this release and fully understand its terms. I execute the release voluntarily and with full knowledge of its significance and consequences. Please make a copy of this form
for your records, as the City will not provide one.
_______________________________________________________________________________________
Participant/parent/guardian signature Date
Supporting the Americans with Disabilities Act, does patron require assistance?
If yes, please specify:
Yes
No
Please return to: Sports Office, 298 Arroyo Grande Blvd., Henderson, NV 89014
Volunteer Coach Information
All coaches are required to obtain certification through the NYSCA. Additionally, all coaches will be required to submit fingerprints for national and state
background checks. Coaches are required to hold two 1-hour practices per week prior to the start of the season and one 1-hour practice per week once
the season has begun. Submittal of this form confirms your interest to become a volunteer coach. Coaches will be selected at the end of registration. The
City of Henderson Parks and Recreation Department reserves the right to deny your volunteer application without explanation.
Have you coached with the City of Henderson Parks and Recreation Department before? Yes No
If yes, please provide your NYSCA member number: ______________________________________
Please indicate your years of experience as a coach:
1
2
3
4
5 or greater
In a brief statement, please describe your coaching philosophy and why you are interested in becoming a volunteer youth sports coach:
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________